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Recent studies have shown that long-term uses of herbs have been associated with a rise in morbidity and mortality rates. While most researches are focused on bioactivity investigations, the toxicity of many plants has not been reported. There is a paucity of data on the potential toxicity of the following plants: Harungana madagascariensis (HM), Pterocarpus osun (PO), Phoenix dactylifera (PD), Annona muricata (AM), and Rutidea parviflora (RP). To evaluate the toxicity of the above-mentioned plants; two tests were employed namely: The Brine shrimp lethality test (BSLT) and the Allium cepa test. A correlation between the oral acute toxicity assay in mice and the LC50 obtained from BSLT has been established. Allium cepa test measures the potential genotoxic effects of plant extracts exerted on the root meristem of A. cepa (onions). Plant extracts were administered in concentrations ranging from 100 to 2500 µg/ml to the A. cepa for 72 h to obtain their Mitotic Indices (MI) and EC50. Results of the MI at 2500 µg/ml for HM, PO, PD, AM, and RP were 3.75, 4.96, 5.96, 6.10, and 6.71 while 281.81, 398.11, 501.19, 630.96, and 707.9 µg/ml were obtained as the respective EC50 values. Furthermore, 10-1000 mcg/ml concentrations were administered in the BSLT and the obtained LC50 values were 116.3, 250, 581.5, 581.5, and 750 µg/ml. The toxicity result demonstrated that the five plants were moderately toxic, with RP exhibiting minimal toxicity values and thus potentially having a good safety profile. The phytochemical screening of these plants revealed the presence of some pharmacologically important classes of compounds that are abundant. Several bioactive and toxic compounds were identified in the GC-MS analysis for some of the plants.

Compacted bentonite or sand-bentonite mixtures are considered buffer/backfill materials in the engineering barriers of deep geological repositories for high-level nuclear waste (HLW) disposal in many countries. The design and long-term functionality of nuclear repositories have critical importance for environmental safety and public health. The initially unsaturated buffer material could become re-saturated long after following the sealing of the repository. Although the saturation degree of the buffer might decrease due to high temperatures and evaporation, it tends to increase with groundwater intrusion. Therefore, the soil water characteristic curves (SWCCs) for these unsaturated soils are a key factor in geotechnical engineering. Yet, the determination of SWCCs can be time-consuming and prone to inaccuracies. The HYPROP (Hydraulic Property Analyzer) evaporation technique is a preferred method for accurately determining water retention curves of soils. This reliable method was applied to estimate the water retention curves for sand-bentonite mixtures in the presence of boron minerals. Known for their minimal thermal expansion and commonly used in various industries, boron minerals may improve the thermal stability of sand-bentonite mixtures. The findings revealed that the boron addition increased the water retention capacity of the 10% bentonite mixtures but had a negligible impact on the 20% bentonite mixtures.

The present review highlights some of the very important contributions to non-alignment ways of comparing biological sequences, which may be genome sequences of nucleotides, protein sequences of amino acids, or sequences of protein secondary structures. The discussion centers around specific methods applicable to the comparison of three types of sequences. The methods of comparison of genome sequences are based on three pairs of biological groups of nucleotides; the same for protein sequences are based on either physio-chemical property values of amino acids or on classified groups of amino acids of different cardinalities obtained from the physio-chemical properties; the same for sequences of secondary structures of proteins are based on their sequential expressions of structure elements of cardinality three and four. Comparison is made in the time domain and also in the frequency domain. Different taxa of known phylogeny are considered for comparison. It tries to find out the specific method of comparison, which can show the exact phylogeny of the taxa. If a new sequence appears in the database, it becomes essential to know its phylogeny. For this purpose, a phylogenetic tree is drawn on the sequences of the known taxa together with this new sequence using the best possible method. If the species having this new sequence belongs to the old taxa, there is nothing to worry about. Otherwise, the species with the new sequence has to be studied separately. This is the general reason for the construction of a phylogenetic tree in any form of biological sequence comparison.

Background: Acute leukemia is the result of clonal transformation and proliferation of a hematopoietic progenitor giving rise to poorly differentiated neoplastic cells. Reactive oxygen species play a role in maintaining the quiescence, self-renewal, and long-term survival of hematopoietic stem cells, but it is unclear how they would affect disease onset and progression. The aim is to evaluate, at the transcriptional and systemic level, the oxidative-inflammatory status in newly diagnosis acute leukemia patients. Methods: Seventy acute leukemia patients [26 acute lymphoblastic leukemia (ALL), 13 Acute Promyelocytic Leukemia (APL), and 31 Acute Myeloid Leukemia (AML)] and forty-one healthy controls were analyzed. Malondialdehyde and catalase activity were evaluated. Gene expression of NRF2, SOD, PRDX2, CAT, IL-6, and TNF-α was analyzed by real-time PCR.Results: Malondialdehyde concentration was similar in all groups studied. Catalase activity was significantly higher in AML and APL patients compared to controls, while ALL showed similar activity to the healthy group. NRF2, CAT, and PRDX2 expression levels were similar between groups, SOD expression was downregulated in all acute leukemia patients. TNF-α expression was lower in AML groups than in healthy individuals, and IL-6 mRNA expression was downregulated in ALL and APL.Conclusion: This is the first report that correlates transcriptional and systemic parameters associated with the oxidative inflammatory status in newly diagnosed acute leukemia. Some of the parameters evaluated could be used as biomarkers in the selection of an effective therapeutic strategy and will open new directions for the follow-up and evolution of this disease.

Gynecological laparoscopy has to be analyzed also in the context of complications that occur during the surgical procedures. Complications occur daily. For this reason, emphasis should be placed on lifelong continuous education and training. Given the risks and complications we face, we must be trained to deal with them. This improves the safety of laparoscopic operations. Without such certainty, gynecological laparoscopy would not be the method of choice in a minimally invasive approach. This requires significant commitment, effort, and responsibility. In this way, we provide our patients with the best and highest quality healthcare service. Likewise, with such an approach, the frequency of complications is reduced to a minimum. New perspectives and possibilities are associated with the application of robotic surgery.

Exposure to microplastics is unavoidable, and a vast amount of microplastics are traveling around the oceans. Microplastics are considered one of the major potential pollutants due to their exposure and interference with the health of humans, animals, aquatic species, agriculture, etc. Shockingly, the microplastic was also detected in the human placenta (fetal and amniochorial membranes), which could cause long-term effects on human health. The disposal of plastic into the oceans is the most happening process across the globe; thereby, microplastic pollution is evident, leading to a huge risk to marine species. Also, the accumulation of microplastics on soil or land leads to an increase in pH value, thereby affecting the surface water and soil-groundwater medium, eventually affecting plant and human health. At the same time, microplastics and their particles are found in milk, meat, and other edible items, which directly affects human health. The appearance of microplastic particles in insects, birds, animals, and even human blood indicates its adverse effect on the environment. This review has discussed the impact of microplastic on the health of humans, aquatic species, and agriculture.

The Blood Flow Restriction (BFR) technique is based on cuffs connected to a pressure device that induces partial arterial inflow. BFR combined with exercise has already been proven to increase strength, muscle mass, and muscular endurance. However, some BFR devices with pneumatic air bands, such as KAATSU (KA), are expensive and less accessible, making either a Sphygmomanometer Cuff (SC) or Elastic Band (EB) an interesting alternative. However, vascular parameters in response to blood flow restriction during KA, EB, and SC have not yet been compared. Purpose: The aim of this study was to compare the brachial blood flow behavior during restriction using bands such as KA, SC, and EB on the same perceived tightness. Methods: Thirty healthy men participated in a prospective crossover study. Participants underwent blood flow measurements before and during KA, SC, and EB use, with KA-perceived tightness taken as a reference. The brachial blood flow volume, the diameter of the artery, and blood flow velocity were measured before and immediately after the cuff’s inflation at a specific tightness. Results: Blood flow volume was significantly reduced in KA (52%, ES: 1.38), SC (61.7%, ES: 1.29), and EB (41.5%, ES: 1.22) (p

The rob(15;22) is one of the rarest translocations which accounts for only 0.6% of the entire Robertsonian translocations reported in humans. A case of rob(15;22) in association with trisomy 21 still has not been reported. In the present study, a case of a 3-year 6-month-old male child with rob(15;22) with trisomy 21 is focused. The phenotype comprises generalized hypotonia, delayed developmental milestones, simian crease, dysmorphic facies, etc. Chromosome analysis with peripheral blood was executed and the karyotype was interpreted as 46,XY,der(15;22)(q10;q10)+21. To analyse whether the chromosomal translocation was de-novo or inherited, the chromosome analysis with the peripheral blood of his parents was performed. The karyotype of the father was interpreted as 46,XY, and of the mother was 45,XX,der(15;22). It was concluded that the rob(15;22) was inherited from his mother, although trisomy 21 was a de novo incidence. Hence, this case study can be proven useful in the understanding of rob(15;22) in solo and rob(15;22) in association with trisomy 21.

Background: Endometrial morular metaplasia, a clinical conundrum from a diagnostic and management angle given its rarity and low oncogenic potential, has been linked to endometrial hyperplasia and carcinoma. Case report: A 77-year-old woman with no significant past medical history, was found to have an asymptomatic thickened endometrium on pelvic imaging, after presenting with lower abdominal pain, 3yrs ago. Diagnostic hysteroscopy identified an endometrial polyp within a pyometra. Histopathology showed focal complex endometrial hyperplasia without atypia with superimposed morular metaplasia(EMM) with a negative microbiology assay.Following conservative management with multidisciplinary team(MDT) overview, as-per patient choice with 6-monthly follow-up hysteroscopy, endometrial biopsies and a short use of the Mirena® Intrauterine system (discontinued following poor tolerance), histopathology shows resolved hyperplasia with persistent EMM. Due to persistent disease, a hysterectomy is under consideration.Discussion: Current evidence suggests that a sub-type of EMM, a likely histological manifestation of beta-catenin (CTNNB1) gene mutation: could be a precursor of endometrial hyperplasia and low-grade endometrioid-endometrial carcinoma sub-type. Though low-grade in nature, the increased recurrence risk raises significant concerns.Prognostication following gene mutation identification can help with management options which include conservative, hormonal therapy with adjunct repeat endometrial sampling: or hysterectomy. The optimal frequency of endometrial sampling when uterine-sparing, is unclear, leading to a management conundrum, whilst persistent disease may require a hysterectomy.Conclusion: Management of endometrial morular metaplasia can be difficult but must reflect the woman’s choice with a MDT-overview. Immuno-histochemical tools utilizing new molecular biological advances, can simplify the diagnostic and prognostication processes, aiding clinical management.

Background: Globally, severe acute malnutrition (SAM) remains a major killer of children under 5 years of age. The highest magnitude is seen in sub-Saharan Africa, including Ethiopia. Hypoglycemia is the most common complication of severe acute malnutrition (SAM) and the most life-threatening condition in pediatric society. This study aimed to assess the prevalence of hypoglycemia and its associated factors among under-five children with severe acute malnutrition.Methods: A cross-sectional retrospective study was conducted among 378 randomly selected samples who were admitted to public hospitals in the East Gojjam zone from 2018 to 2021. Data was extracted from the medical records of the children and entered into SPSS version 26, Variables with a p – value < 0.25 in the Bivariate analysis were candidates for multivariable logistic regression and those with a p – value < 0.05 in the multivariable analysis were considered as having a statistically significant association with hypoglycemia among severe acute malnutrition.Results: Out of 378 respondents, 50 (13.2%) had hypoglycemia with severe acute malnutrition patients. Children admitted between the ages of 0-6 months were 2.93 (AOR = 1.57-6.25, p = 0.000), shocks were 4.6 (AOR = 1.25-17.42, p = 0.034), and fully immunized children were (AOR: 2.61 (1.01- 6.77, p = 0.048) was significantly associated with hypoglycemia with severe acute malnutrition. Conclusion and recommendation: The prevalence of hypoglycemia with severe acute malnutrition was 13.2%. We also recommend a longitudinal study should be done among children who develop hypoglycemia with severe acute malnutrition to determine the long-term consequences, especially the neurodevelopmental sequelae associated with this condition.

Background: Worldwide, obesity in adolescents is an epidemiological concern. Overweight and obesity are associated with comorbidities in adult life, such as increased risk of hypertension and other non-communicable diseases. This study investigated possible differences between traditional lipid markers and Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL) subfractions in a population-wide representative sample of Brazilian adolescents. Methods: The individuals included in the study comprise a subsample of the 2015 Health Survey of São Paulo (ISA-Capital 2015). LDL and HDL particle sizes were determined by the Lipoprint® System (Quantimetrix Corporation). Results: 272 Brazilian adolescents with a mean age of 15.2 ± 2.2 years, of which 47.8% (n = 130) are boys. Analysis of LDL subfractions showed an increase in LDL 2 content in girls (5.7% vs. 5.1%; p = 0.047). This result was associated with a higher content of large LDL in girls (17.8% vs. 13.5%; p < 0.001) and a significant, lower content of small LDL (1.7% vs. 3.4%; p = 0.002). When obesity was considered, we observed that regardless of being overweight, girls had higher large and small LDL than boys. However, when a large to small LDL ratio was calculated, girls with no excess weight had higher values than boys with no excess weight (10.6 vs. 9.3; p = 0.038), and these had lower LDL ratio than overweight boys (9.3 vs. 13.5; p = 0.016). On the other hand, boys had higher HDL 2 content than girls (8.9% vs. 8.0%; p = 0.017), which was associated with increased large HDL values in boys (1.9% vs. 1.7%; p = 0.047). Regression analysis was performed according to gender, the sum of very low-density lipoprotein (VLDL) + intermediate density lipoprotein (IDL) C + IDL B subfractions was adjusted for age and body mass index (BMI), showing that girls had lower atherogenic lipid profile (β = 0.987; CI = 0.977-0.998; p = 0.017) than boys. When the regression analysis was performed according to BMI, large LDL in adolescents with no excess weight presented a lower atherogenic lipid profile (β = 1.040; CI = 1.000-1.082; p = 0.049), adjusted for age and sex, than overweight adolescents.Conclusion: Regardless of excess weight, girls showed a cardioprotective profile more associated with a favorable distribution of LDL subfractions than boys, reinforcing the relevance of evaluating qualitative aspects of lipoproteins in addition to the traditional cholesterol content.

Type 2 diabetes mellitus (T2DM) is the most common cause of chronic kidney disease (CKD). CKD is characterized by progressive liver tissue damage and is an important risk factor for mortality due to renal and cardiovascular outcomes. Thus, randomized clinical trials have investigated the use of sodium-glucose cotransporter 2 (SLGT2) inhibitors as a promising therapy for patients with CKD and T2DM. This study aimed to analyze the benefits of using SGLT2 inhibitors in patients with CKD and T2DM to reduce mortality risks. To this end, a qualitative, descriptive methodological approach was adopted using a literature review in the PubMed, Embase, and VHL databases. The inclusion criteria were clinical trial articles, randomized or non-randomized, cohort studies, case-control studies, and open access, published in Portuguese and English, between 2018 and 2023 with topics associated with SGLT2 inhibitors, CDK, and T2DM patients. In this context, it was observed that the risk of death from CKD in patients treated with Canaglifozin was 30% lower than in those treated with a placebo and that Dapaglifozin prolonged survival. In this context, when assessing the progression of kidney disease or death from cardiovascular causes in patients taking Empagliflozin, only 13.1% achieved the outcome compared to 16.9% on placebo, so the drug safely reduces the risk of mortality. Consequently, SGLT2 inhibitors have shown excellent results in the treatment of CDK and T2DM, with a reduction in the risk of mortality, positive effects on reducing renal and cardiovascular outcomes, as well as prolonging survival.

DNA evidence has now become an essential part of forensic investigations since it offers vital information for person identification and crime resolution. However, the biological material is affected by some environmental factors which may impact the DNA in biological samples. This may affect the correctness and reliability of forensic DNA analysis. This review is related to the influence of various environmental conditions on the stability and degradation of DNA in biological stains including blood and saliva stains. The common factors that affect DNA are temperature, humidity, exposure to sunlight, and type of substrate. The information is crucial to improve forensic DNA analysis and forensic protocol optimization. The DNA stability and integrity in biological materials, such as blood and saliva stains, are indispensable for forensic DNA analysis. Environmental influences, however, significantly affect DNA concentration and may jeopardize forensic analysis. The present review explores various environmental factors for their effect on DNA stability in blood and saliva stains. While DNA degradation is slowed but not completely prevented by low temperatures, it is accelerated by high temperatures. Risks of contamination arise from the promotion of microbial growth and DNA breakdown by humidity. DNA photodamage brought on by sunlight exposure results in strand breakage and cross-linking. DNA stability is also influenced by the type of substrate used; porous surfaces, such as cloth, are better at keeping fluids than non-porous ones, such as glass. Maintaining the integrity of DNA evidence requires an understanding of these variables. The present studies will help to create sophisticated DNA preservation methods for use in forensic DNA examination. The study emphasizes the requirement of improvement in forensic DNA analysis skills, related to the preservation of DNA pieces of evidence and the possible effect of environmental factors.

Introduction: Post-dilution online hemodiafiltration is the most efficient extracorporeal depurative treatment of CKD. Recently a new type of membrane has been developed, with a higher cut-off point also called a medium cut-off point, which has the capacity to eliminate higher molecular weight molecules in hemodialysis. The hemodialysis performed with these membranes has been called “Expanded Hemodialysis”.Objective: Compare the purifying efficacy of medium and high molecular weight molecules in patients dialyzed with high-flux hemodialysis, VitaPES 210HF, and with patients treated with expanded hemodialysis with the medium cut-off dialyzer, Elisio-HX.We also assessed the effect that the increased removal of inflammatory mediators by MCO hemodialysis had on fecal Calprotectin levels.Patients and methods: This is a prospective observational cross-over study in which 8 prevalent hemodialysis patients were followed for two months. Blood levels of IL-6, C-reactive protein (CRP), β2-microglobulin, Kappa and Lambda immunoglobulin light chains, and serum albumin were determined before and after each hemodialysis session.Results: The percentage of reduction of medium and higher molecular weight molecules: β2microglobulin, IL-6, Kappa and Lambda chains and CRP were higher with the Elisio-21HX dialyzer compared to the VitaPES 210HF dialyzer. There was no difference in albumin clearance between the two dialyzers.Fecal calprotectin levels were lower in patients dialyzed with Elisio-21HX.Conclusion: The medium cutoff dialyzer, Elisio-HX, is more efficient in the elimination of medium/high molecular weight molecules than the VitaPES HF high-flux dialyzer, with the same albumin elimination.Improving inflammation at the local intestinal level with lower levels of fecal Calprotectin.

Immune Checkpoint Inhibitors (PCIs,) are monoclonal antibodies directed against immune checkpoint regulatory molecules. These antibodies inhibit T-cell activation and prolong survival in patients with different types of cancer. However, they can produce adverse effects related to the immune response such as renal damage.We present the clinical case of a 75-year-old man with a personal history of Chronic Kidney Disease (CKD) and metastatic renal cancer with lung, bone, and mediastinal involvement. He started treatment with immunotherapy with Nivolumab-Ipilimumab. Then, after 4 cycles of immunotherapy, the patient was admitted to the Urology Department for an adverse reaction to immunotherapy with the development of nephritis and toxic hepatitis. Despite treatment with methylprednisolone, he evolved poorly, and a palliative approach was finally decided.The incidence of acute renal failure attributed to PCIs is estimated at 2% - 3%, being grade I-II in most cases. Among the renal complications associated with PCIs, acute interstitial nephritis is the most predominant with an incidence of 80% - 90% of cases. In addition, an increased risk is observed in patients with intermediate or poor risk metastatic renal cancer.Despite their fundamental role in metastatic renal cancer, we must take into account the potential for renal failure as an adverse effect of PCIs, especially in patients with previous CKD.

Aim: This study examines the pathological outcomes of chronic liver injuries, with a focus on liver fibrosis. It emphasizes understanding the structural changes within the liver that may lead to cirrhosis and functional impairments, crucial for developing targeted antifibrotic therapies.Methods: Our approach reviews existing literature detailing the use of traditional diagnostic methods—biochemical and serological tests alongside liver biopsies. Additionally, we evaluate the reliability and efficacy of non-invasive techniques such as serological test panels and imaging examinations. These methods are compared to understand their viability as supplementary or alternative diagnostic tools to liver biopsy.Significance: Liver fibrosis, if unmanaged, can progress to severe conditions such as cirrhosis and hepatocellular carcinoma, making it vital to understand its progression and treatment options. This study underscores the need for precise and non-invasive diagnostic tools in the clinical management of liver fibrosis, providing insight into the progression of chronic liver diseases and potential therapeutic targets.Conclusion and future perspectives: The research confirms that while liver biopsy remains the definitive method for staging liver fibrosis, its risks and limitations necessitate the use of enhanced non-invasive diagnostic techniques. These methods have shown promising results in accuracy and are critical for broadening clinical applications and patient safety.It is recommended that the scientific community continue to develop and validate non-invasive diagnostic tools. Enhancing the accuracy and reliability of these tools can provide a cost-effective, accessible, and safer alternative for large-scale screening and management of liver fibrosis in asymptomatic populations. Additionally, integrating advancements in radiologic and serological markers can further refine these diagnostic methods, improving overall patient outcomes.

This study compares the effect of imipramine and amitriptyline on learning and memory. Thirty-five (35) healthy Swiss white (CD1) mice of both sexes weighing 18 g - 30 g were randomly divided into 5 groups (n = 7). Mice in group 1 (control) were administered 0.9% normal saline orally, while mice in groups 2 and 3 were treated with low (1.8 mg/kg) and high (3.7 mg/kg) doses of imipramine, groups 4 and 5 were treated with low (1.8 mg/kg) and high (3.7 mg/kg) of amitriptyline respectively. Treatment was for 21 days before tests. All animals were tested using the Morris Water Maze (MWM) and Novel Object Recognition Task (NORT) to assess visuospatial learning and memory as well as cognitive learning and memory. The results obtained from the Morris Water Maze during the acquisition training showed that the swim latencies were significantly lower (p < 0.05) in the amitriptyline low-dose group compared to the control group. During the reversal training, the swim latencies were significantly lower (p < 0.05) in the test groups compared to the control group. The result for the retention quadrant in the probe trials showed a significant decrease (p < 0.05) in the northeast quadrant in the test groups compared to the control group, with no significant difference in the visible platform day of the Morris Water Maze in the test groups compared to the control group. In the novel object recognition task, the short-term index of habituation was significantly lower (p < 0.05) in the low-dose imipramine and low-dose amitriptyline compared to the control group, the results also showed a significant increase (p < 0.05) in amitriptyline high dose group compared to imipramine and amitriptyline low dose group and the control group. The index of discrimination showed no significant difference among all groups. The long-term index of habituation and discrimination in the memory test showed a significant decrease (p < 0.05) in all the test groups compared to the control group. The results suggest that imipramine and amitriptyline impaired cognitive memory and enhanced visuospatial learning and memory functions.

This study investigates into the historical evolution and contemporary applications of Computed Tomography (CT) in renal stone estimation, with a focus on the innovative use of CT to quantify renallcalculiistrain for estimating potentiallsymptomatic incidents.Historically, CT has played a pivotal role in diagnosing renal calculi, offering unparalleled sensitivity and specificity in detecting stones of varying composition and size. However, the clinical significance of renal calculi extends beyond mere detection, prompting researchers to explore novel approaches to predict symptomatic events associated with stone disease. This research aimed to determine the right way to classify asymptomatic radiographic calculi strain on computed tomography (CT) scans in Al-Hussein Teaching Hospital, Al-Muthanna, Iraq. A survey was made available to calculi formers who had a CT scan during asymptomatic after a calculi clinical assessment. A survey and a study of medical records revealed symptomatic calculi route incidents after a CT scan. The amount of calculus, the biggest calculi thickness, electronic total calculi size (TSV), and two-pronged calculus were measured radiographically and linked as predictors of calculi events. There were 55 calculi formers in the study, and 61% had a calculi event one year after the CT scan. The calculus number was (0–1, 2–3, 4–6, 7), the highest calculi diameter was (0–2, 3–4, 5–7, 8 mm), and 48% had bilateral calculus. The number of calculus per quartile had a danger ratio of 1.30 (p = 0.001), the largest calculi diameter had a hazard ratio of 1.26 (p  0.001), TSV had a hazard ratio of 1.38 (p = 0.001), and bilateral calculus had a hazard ratio of 1.80 (p = 0.001). Only TSV wass an unbiased measure offsymptomaticceventssin multivariable regression (HR = 1.35 per quartile, p = 0.01). TSV-related incidents were also unaffected by demographics, urinary chemistry, or calculi composition. A drastic rise in TSV between CT scans (> 31 mm3/year) expected additional eventssin the 49 patients with interim events (HR = 2.8, p = 0.05). For calculating calculi pressure on CT scan, automated TSV is more accurate for asymptomatic events than physical approaches.

A 51-year-old female with a history of multinodular goitre presented with vomiting, abdominal discomfort, and generalized tiredness. Investigations revealed hypercalcemia (ionized calcium 1.41 mmol/L), hypokalaemia, suppressed parathyroid hormone, and significantly elevated free thyroxine (> 7.77 ng/dL) with a suppressed thyroid-stimulating hormone level consistent with hyperthyroidism. Further, the workup confirmed Graves’ disease as the underlying aetiology. Hyperthyroidism is occasionally associated with mild to moderate hypercalcemia, but severe hypercalcemia or hypercalcaemic crisis is an extremely rare complication. Prompt recognition and treatment are crucial to prevent life-threatening complications. The patient was treated with intravenous fluids, a low-calcium diet, zoledronic acid, carbimazole, and a beta-blocker, leading to improvement in her condition. This case highlights a rare occurrence of hypercalcaemic crisis in a patient with thyrotoxicosis due to Graves’ disease. Hyperthyroidism-induced hypercalcemia requires prompt recognition and multidisciplinary management involving endocrinologists, internists, and critical care specialists to prevent potentially life-threatening complications. Healthcare providers should consider the hypercalcaemic crisis in the differential diagnosis of hypercalcemia in the context of hyperthyroidism.

The physiological removal of foreign bodies in the horse’s external ear canal is best achieved by head-shaking. However, external otitis in the horse induces moderate to severe pain: therefore, the horse does not shake his head. The causes of external otitis are dust, water in the external ear canal, keratin, and ceruminous debris. The clinical symptoms are ear discharge, skittishness, facial nerve paresis, and/or head tilt. After the horse has been sedated, the most important diagnostic procedure is the endoscopy of the cartilaginous and osseous part of the external ear canal, including the evaluation of the transparency of the tympanic membrane. The clinical complications of external otitis are hearing loss, facial nerve paresis, head tilt, hypertrophy of the tympanostylohyoideum, and corneal ulcers. The most important treatment is soaking up the exudate in the osseous part of the external ear canal using small cotton balls which are held by the foreign body forceps of the endoscope. Based on the results of the culture of exudate and the antibiogram, an antibacterial drug must be administered orally for 3 to 4 weeks. At this time, an endoscopy of the external ear canals and guttural pouches also has to be done. Based on the outcome of the endoscopy, endoscopic and clinical investigations have to be performed six months later as well. Only 7/19 horses had a normal osseous part of the external ear canal with a transparent tympanic membrane, including normal hearing measured by the brainstem auditory-evoked response after one month of treatment.